Unipolar Depression Diagnostic and Therapeutic Recommendations From the Current S3/National Clinical Practice Guideline
Unipolar Depression Diagnostic and Therapeutic Recommendations From the Current S3/National Clinical Practice Guideline
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DOI：
10.3238/arztebl.2010.0700
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发表时间：
2010-10-08
影响因子：
7.7
通讯作者：
Berger, Mathias
中科院分区：
文献类型：
--
作者：
Haerter, Martin;Klesse, Christian;Berger, Mathias
背景：抑郁症是最常见的疾病之一，也是获得医疗保健的原因。其诊断和治疗仍需改进。在德国，一个新的S3/国家临床实践指南已经开发了用于此purpose.Methods：从德国和其他国家的单相抑郁症的现有指南进行了概要比较，并补充了系统的文献检索。结果：根据ICD-10诊断标准，单相抑郁症的诊断符合ICD-10诊断标准。筛查问卷是诊断分类的有用辅助工具。当选择治疗时，与患者共同决策至关重要。轻度抑郁发作最初可以通过观察等待14天来治疗。对于中度抑郁发作，药物治疗和心理治疗是同样有效的治疗选择。对于严重的抑郁症，建议药物治疗和心理治疗相结合。如果4至6周的急性治疗效果不佳，建议增加锂，而不是联合抗抑郁药治疗或改用另一种抗抑郁药。缓解后应继续维持治疗4 ~ 9个月。复发性抑郁症，药物治疗和/或心理治疗，如果适当的话，应继续至少两年。具体的建议，给病人谁有躯体或精神共病或急性自杀，并建议也给予协调care.Conclusion：本指南是一个全面的一套证据和共识为基础的建议，诊断和治疗单相抑郁症。改善单相抑郁症患者的护理需要在住院和门诊环境中广泛实施该指南。
Background: Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose.Methods: The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued.Results: Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care.Conclusion: This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.